Published January 5, 2018 Updated May 24, 2019
"Myths About Circumcision You Likely Believe" is the first in a series of 2011 articles published in Psychology Today that are often cited by circumcision opponents. Authors Lillian Dell-Aquila Cannon and Darcia Narvaez seek to dispel several common understandings about the procedure that they see as inaccurate. Ironically much of the evidence offered to refute the "myths" is inaccurate, unsupported, or out of date. First read the article at this link.
MYTH 1: They just cut off a flap of skin.
The authors stated, "the foreskin is 15 square inches of skin," without explaining that the measurement includes both outer skin AND inner lining. That figure is at the very high end of the spectrum. According to TheCircumcisionDecision.com, some experts say that the visible area of the foreskin is 5.7 to 7.2 square inches. A 2008 study in Uganda reported a rage from 1.1 to 15.5 square inches;the average was 6.0 square inches.
The authors falsely claimed that the tissue that adheres the foreskin to the glans is the same type as the tissue that adheres a fingernail to a finger bed. They offered a crude and inaccurate description of the Gomco procedure: “Removing [the foreskin] requires shoving a blunt probe between the foreskin and the head of the penis and then cutting down and around the whole penis." An OB/GYN associated with Circumcision Choice explained what actually happens.
"The foreskin is grasped at 9 and 3 o'clock and a hemostat is used to loosen the skin from 9-3. Then the stat is clamped down. This crushes the nerves and a pair of scissors is used to cut where the nerves were blocked. Then the glans is exposed and the blunt probe is used to take down any further adhesions to the base of the glans. Then it is pulled back over the glans and the Gomco bell is placed over the glans and the foreskin is pulled up the rest of the device and then adjusted to make sure the skin is equally pulled through. The bell is tightened down, which crushes the nerves and blood vessels. Then the scalpel is used to cut metal to metal protecting the glans. Then it's all removed and checked for any bleeding. Then wrapped in Vaseline gauze and extra Vaseline."
MYTH 2: It doesn't hurt the baby.
The myth that babies don't feel pain is untrue. However the authors overstated their case. They cited a 1997 Lander study in which babies in the control group received no anesthesia. The use of adequate pain relief renders this point moot.
MYTH 3: My doctor uses anesthesia.
To support their point that a majority of doctors don't use anesthesia, they pointed to a 1998 study which reported that only 45% of doctors who performed circumcisions used anesthesia. But since that study was published, both the 1999 AAP Task Force and the 2012 Task Force recommended that circumcision patients should receive adequate pain relief. And a University of Rochester study showed that by 2003 some 97% of residency programs recommended the use of anesthesia. So it's likely that most circumcision patients today receive effective pain relief.
MYTH 4: Even if it is painful, the baby won't remember it.
Cannon and Narvaez cited Taddio's 1997 study and Anand's 2000 study to support the claim that circumcision rewires a baby's brain so that he is more sensitive to pain later. Taddio used a small sample size and did not examine patients after the age of six months. The U.S. Centers for Disease Control observed that Taddio "compared use of topical lidocaine-prilocaine cream (EMLA) with placebo", but "did not include a study arm for more effective methods of analgesia such as dorsal penile nerve block (DPNB) or subcutaneous ring block. It is unclear whether the study results would have been the same had another arm with a more effective analgesic modality been included."
Anand stated possible effects of "exposure to repetitive pain." However circumcision is normally a singular event. Anand noted, "Little is known about the effects of full-term pain in neonates. Circumcision seems to disrupt their post-natal adaptation." Anand didn’t conduct any independent experiments. It's unclear how this study validates the rewiring claim.
The authors cited Boyle (2002), Goldman (1999), and Hammond (2003) to support their claim that "circumcision can cause PTSD, depression, anger, low self-esteem, and problems with intimacy."
The CDC noted that Boyle "focused on psychological effects of circumcision based on performing circumcision without anesthesia, which is not the standard of care recommended by the American Academy of Pediatrics." Boyle cited Rhinehart, a psychologist who reported that several of his middle-age patients suffered PTSD and claimed that many of them remembered their own circumcision. Rhinehart failed to consider the possibility that the psychologist himself guided his patients to associate their problems with circumcision.
Goldman conceded that “there is no empirical research on circumcision trauma and memory.” He admitted that "the effects of circumcision trauma can be chronic and so deeply embedded that it is very difficult to distinguish them from personality traits or effects resulting from other causes.” In other words, a researcher with an anti-circumcision agenda who is looking for psychological harm might mistakenly attribute as circumcision trauma what are actually personality traits or mental problems from other causes. Goldman speculated that newborns might be able to retain memory of trauma. But Strange reported that “early memories are extremely rare” and adults “appeared to have a reduced threshold for accepting” details regarding [false] memories from age 2. Strange concluded that “childhood amnesia increases [the] susceptibility to false suggestion.”
Hammond conducted a survey of 313 men for the anti-circumcision group NO-HARMM. The respondents were self-selected, and data was collected from self-reporting, which is considered a less reliable method for data collection than researcher examination. In analyzing Hammond's paper, the CDC found that the study "lacks a detailed description of its methodology or whether an attempt was made to obtain responses from a representative sample of circumcised men, or simply to men who are against circumcision." Hammond's results conflict with a 2015 Queen's University study that utilized standardized measures and was less susceptible to selection bias.
Hammond claimed that “assumptions that men circumcised in childhood are satisfied with or suffer no adverse effects from circumcision have no scientific foundation.” But a 2015 survey of 1000 American men showed that just 10% of circumcised men were dissatisfied with their circumcision status, compared to 29% of uncircumcised men. Hammond descended into ad hominem attacks against critics, claiming that skeptical circumcised men seek to “protect themselves from feelings of inferiority” by denying that circumcision harms men physically and sexually.
Cannon and Narvaez suggested that it's wrong to inflict any amount of pain regardless of whether the patient will remember. Yet many non-therapeutic procedures involve pain, including the blood test that was forced upon this author at age four. Should hospitals cease to inflict blood tests on non-consenting minors who are screaming bloody murder?
MYTH 5: My baby slept right through it.
Neurogenic shock is a life-threatening medical condition. An infant in shock will have low blood pressure, his skin will turn blue, and he may stop breathing. A baby in neurogenic shock does not appear to be sleeping. Immediate medical treatment is required. It's not possible that a trained physician will mistake shock for sleep.
One of my closest friends is an anesthesiologist who has practiced for more than 20 years. When I asked her about the claim that circumcision causes babies to go into shock, she replied that it’s absolutely false.
The authors failed to cite a single study or expert to support their fanciful claim that circumcision causes babies to go into shock.
MYTH 6: It doesn't cause the baby long-term harm.
The authors equated the risk of harm with actual harm. Cannon and Narvaez asserted a 1-3% complication rate during the newborn period, citing a 1990 pediatric book. They listed several potential complications, including meatal stenosis, adhesions, buried penis, and infection. According to the 2012 AAP technical report, “Significant acute complications are rare, occurring in approximately 1 in 500 newborn male circumcisions.”
The authors claimed that "over 100 newborns die each year in the USA," citing the 2010 Bollinger study that has been thoroughly refuted. They also cited two Van Howe papers. The 1997 study didn't discuss circumcision deaths. The 2004 study discussed the difficulty in determining actual death statistics, provided no U.S. mortality rates, and used a figure of 9-12 deaths in 80,000 patients derived from a British report for its circumcision cost-analysis. Speert reported 1 death in 566,000 circumcisions in New York during 1939-1951. And a 1989 Wiswell study reported no deaths in 100,000 circumcisions performed in U.S. Army hospitals during 1980-1985.
Conclusion
The authors effectively refuted the assertion that circumcision causes no pain. The rest of their work is sloppy, outdated, misleading, and unpersuasive. When it comes to facts about circumcision, Lillian Dell-Aquila Cannon and Darcia Narvaez are the mythmakers.
Also read this critical analysis: Debunking another "myths" article.
For my analysis of Circumcision's Psychological Damage, click here. #MythsAboutCircumcision #CircumcisionMyths #PsychologyToday